Provider Demographics
NPI:1215387188
Name:LUZVIRGINIAWERTHER
Entity Type:Organization
Organization Name:LUZVIRGINIAWERTHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:WERTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-394-2835
Mailing Address - Street 1:10198 SW 199TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8625
Mailing Address - Country:US
Mailing Address - Phone:954-394-2835
Mailing Address - Fax:
Practice Address - Street 1:10198 SW 199TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8625
Practice Address - Country:US
Practice Address - Phone:954-394-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty